title: Noninvasive tests for fibrosis and liver stiffness predict 5-year outcomes of patients with chronic hepatitis C.
abstract: OBJECTIVE
  Liver stiffness can be measured noninvasively to assess liver fibrosis in patients with chronic hepatitis C. In patients with chronic liver diseases, level of fibrosis predicts liver-related complications and survival. We evaluated the abilities of liver stiffness, results from noninvasive tests for fibrosis, and liver biopsy analyses to predict overall survival or survival without liver-related death with a 5-year period.
  
  
  METHODS
  In a consecutive cohort of 1457 patients with chronic hepatitis C, we assessed fibrosis and, on the same day, liver stiffness, performed noninvasive tests of fibrosis (FibroTest, the aspartate aminotransferase to platelet ratio index, FIB-4), and analyzed liver biopsy samples. We analyzed data on death, liver-related death, and liver transplantation collected during a 5-year follow-up period.
  
  
  RESULTS
  At 5 years, 77 patients had died (39 liver-related deaths) and 16 patients had undergone liver transplantation. Overall survival was 91.7% and survival without liver-related death was 94.4%. Survival was significantly decreased among patients diagnosed with severe fibrosis, regardless of the noninvasive method of analysis. All methods were able to predict shorter survival times in this large population; liver stiffness and results of FibroTest had higher predictive values. Patient outcomes worsened as liver stiffness and FibroTest values increased. Prognostic values of stiffness (P<.0001) and FibroTest results (P<.0001) remained after they were adjusted for treatment response, patient age, and estimates of necroinflammatory grade.
  
  
  CONCLUSIONS
  Noninvasive tests for liver fibrosis (measurement of liver stiffness or FibroTest) can predict 5-year survival of patients with chronic hepatitis C. These tools might help physicians determine prognosis at earlier stages and discuss specific treatments, such as liver transplantation.
authors.affiliation: Centre d'Investigation de la Fibrose hépatique, Hôpital Haut-Lévêque, CHU Bordeaux, Pessac, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Vergniol
authors.forename: Juliette
authors.initials: J
authors.lastname: Foucher
authors.forename: Eric
authors.initials: E
authors.lastname: Terrebonne
authors.forename: Pierre-Henri
authors.initials: PH
authors.lastname: Bernard
authors.forename: Brigitte
authors.initials: B
authors.lastname: le Bail
authors.forename: Wassil
authors.initials: W
authors.lastname: Merrouche
authors.forename: Patrice
authors.initials: P
authors.lastname: Couzigou
authors.forename: Victor
authors.initials: V
authors.lastname: de Ledinghen
mesh_terms: D000328:Adult; D000368:Aged; D001219:Aspartate Aminotransferases / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D016009:Chi-Square Distribution; D004796:Clinical Enzyme Tests; D054459:Elasticity Imaging Techniques; D005260:Female; D005602:France; D019698:Hepatitis C, Chronic / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy / Q000821:virology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors
chemical_list: D015415:Biomarkers; D001219:Aspartate Aminotransferases